Provider Demographics
NPI:1548574643
Name:ROPER, JESTINE GLANNIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESTINE
Middle Name:GLANNIE
Last Name:ROPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 AMBOY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5024
Mailing Address - Country:US
Mailing Address - Phone:718-346-0941
Mailing Address - Fax:
Practice Address - Street 1:129 AMBOY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5024
Practice Address - Country:US
Practice Address - Phone:718-346-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO390561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical